January 2020 – Uncertainty is my only certainty

2020 started with a new set of scans. This time I got to do the whole lot: an MRI, a CT and a PET.

The MRI was performed on the 9th January and the report was delivered the following day. Results were somewhat mixed: while the pancreas appeared to be completely free of disease, a small and isolated lesion (5mm) was identified in the liver. The report concluded that the lesion looked suspicious, although it did not show all the features of a metastasis.

This news was given to me just a couple of hours after my parents had arrived to spend three days with us in London. Despite the fact that the MRI report was inconclusive regarding the exact nature of the lesion, the possibility that the cancer was back inevitably had a negative impact on everyone’s mood.

I underwent the PET and CT scans on the 20th January and these unfortunately confirmed that the lesion was metastatic. Surprisingly, I did not get too upset as my brain somehow had prepared itself for this eventuality during the previous 10 days. And, very helpfully, my oncologist quickly suggested a way forward: immediate surgical removal of the metastasis and continuation of chemotherapy going forward to reduce the likelihood of further recurrence.

The operation suggested by the oncologist is called “radiofrequency ablation”, which is routinely used to remove small tumours. The procedure involves the insertion of a needle through the skin, after which a high-frequency current is used to heat the tumour and destroy the cancer cells. Importantly, the operation is performed under CT guidance and requires sedation or general anaesthesia.

In my case, the doctor in charge of the ablation told me that he would prefer to opt for general anaesthesia. My memory of the first attempted biopsy back in February 2019, where a large needle was repeatedly, uncomfortably and unsuccessfully inserted in my liver while I was fully awake made me instantly love the guy and I immediately agreed with his strategy.

The ablation took place at 5pm on the 28th January. I had decided that it would make no sense to tell the children about it, since they would have got unnecessarily worried about the operation and what it could have meant for the future. Instead I told them that I had to go to Brussels for a business meeting and that I would be back the following day. It was yet another lie, but I did not feel guilty about it.

I was admitted to hospital in the morning and, while I was waiting for the doctors to take me to the operating room, I felt no noticeable apprehension about what was about to happen. I knew that the doctor in charge was extremely experienced and, like a passenger on an airplane, I felt reassured by the fact that it was all in the hands of an experienced pilot and not mine.

This is not to say that I felt relaxed. On the contrary, the appearance of the metastasis reminded me of how serious pancreatic cancer is and that the removal of the primary tumour did not provide a complete cure.

At the same time, I felt “happy” that following the operation in Heidelberg, I had decided to undergo post-surgery chemotherapy as suggested by my oncologist rather than adopt a wait-and-see approach. If I had not followed his advice, I would have probably faced a much worse scenario than the simple removal of a small and isolated liver metastasis.

In the end, the ablation went well and the doctor who performed it reassured me that he could not find any other lesion in the liver, which was great news. I was in pain for the rest of the day and was given both Codeine and liquid morphine. I slept well during the night and the following morning I woke up feeling well and pain-free. After a further CT scan aimed at making sure that everything was fine, I was allowed to leave the hospital and go home.

That evening I was greeted by the children who asked me about the Brussels meeting. Luckily an “it went well!” was enough to satisfy their curiosity and we quickly moved on to other subjects….

So how do I feel now that the liver metastasis has gone? In theory I am cancer-free again, but inevitably this development has had the effect of increasing the perceived uncertainty about my future.

One part of me likes to think that the lesion was the last thing that had to be removed and that the further chemotherapy cycles I will do in the next few months will kill any remaining cancer cells that may still be moving around my body. But another part of me fears that the illness may come back aggressively and take my life within a short period of time.

As my great friend Steven acknowledged during one of our conversations, “uncertainty is my only certainty”. But thanks to the support of my family and friends, I am managing to cope relatively well, relying as always on my eat/exercise/work/sleep routine as well as on meditation and the daily practice of gratitude.